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Triple Negative Breast Cancer Treatment

Treatment For Triple Negative Early Breast Cancer

Chemotherapy Options for Triple Negative Breast Cancer

Treatment for triple negative early breast cancer may involve:

As triple negative breast cancer is usually very responsive to chemotherapy, your medical oncologist will most likely develop a chemotherapy treatment plan for you. This will take into account your own individual needs and preferences.

Chemotherapy for triple negative breast cancer is often given before surgery. This is called neoadjuvant chemotherapy. There are a number of benefits in having chemotherapy before surgery.

  • You can see if the chemotherapy is working .
  • You may be able to have breast conserving surgery instead of mastectomy if the tumour shrinks enough.
  • It gives you time to have genetic testing done to determine if you have an inherited gene mutation if the test comes back positive it may affect your decision around what type of surgery to have.

Treatment for triple negative breast cancer may also include radiotherapy after surgery, especially if you have breast conserving surgery.

You may be offered immunotherapy treatment through a clinical trial, although there are strict eligibility criteria. You can talk to your medical oncologist about any clinical trials that may be suitable for you.

Intracellular Signaling Pathway Targets

PI3K/AKT pathway

A wide range of malignancies including TNBC show dysregulated phosphatase and tensin homolog /phosphoinositide 3-kinases /protein kinase B /mammalian target of rapamycin signaling due to mutations in multiple signaling components. Loss of PTEN, a negative regulator of AKT, was found to be correlated with decreased T-cell infiltration at tumor sites in patients, and inhibition of the PI3K-AKT pathway re-sensitized to T-cell-mediated immunotherapy . As the PI3K/AKT pathway has emerged as a potential mechanism of resistance to immunotherapy and chemotherapy, multiple clinical trials have assessed inhibitors of the various pathway components.

Alpelisib is an oral PI3K inhibitor that selectively inhibits p110. It showed efficacy in targeting Pik3ca-mutated breast cancer and was FDA approved in 2019 in combination with fulvestrant for postmenopausal women and men, with HR+, HER2-negative, Pik3ca-mutated, advanced or metastatic breast cancer following progression on or after an endocrine-based regimen. For patients with advanced TNBC, the EPIK-B3 Phase III trial is planned with study start date of April 2020 to assess alpelisib in combination with nab-paclitaxel. Patients have Pik3ca mutations or PTEN loss with 1 prior line of therapy for metastatic disease.

Basal Cell Breast Cancer

Basal cell breast cancer is a type of breast cancer with a clear pattern of changes in proteins in the cells.

Cancer doctors recognise basal cell breast cancer when they examine the cancer cells under a microscope. It is often linked with triple negative breast cancer.

Basal cell breast cancers are usually triple negative. And most triple negative breast cancers are basal cell cancers. They are similar types of breast cancer, but not exactly the same.

See also

The symptoms of triple negative breast cancer are the same as for other breast cancer types.

See also

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Which Treatment Is Right For You

Doctors use the same tests and surgeries to figure out treatments for triple-negative breast cancers as they do for other kinds of breast cancer. Your treatment will be based on tumor size, tumor grade and whether the cancer has traveled to your lymph nodes or other parts of your body. Standard treatment options for triple negative breast cancer include chemotherapy, surgery and radiation.

Molecular Subtypes And Characteristics Of Triple

Targeted Therapies for Triple

To avoid blindly developing therapeutic strategies, identifying the complex TNBC subtypes and molecular hallmarks is necessary given that these features are closely linked with clinical outcomes, for example, response to chemotherapy, the pattern of recurrence, and prognosis. Different approaches, including somatic DNA mutation, copy number aberrations, gene expression profiling, and immune metagene information, were applied to analyze TNBCs as a highly diverse group of cancers.

Additionally, molecular alterations were assessed to explore various potential targets for TNBC treatment. It is worth mentioning that a deficiency in homologous recombination, which is partly associated with the loss of breast cancer susceptibility gene function in BC, is correlated with a good response to cisplatin treatment . In an early phase II clinical trial, patients with BRCA-mutant TNBC showed an overall response rate of 80% with single cisplatin therapy . A deficiency in homologous recombination means failure to repair DNA double-strand breaks and damaged DNA replication forks. Therefore, these individuals are also sensitive to poly-adenosine diphosphate -ribose polymerase inhibitors , as PARP is the enzyme that responds to repair DNA single-strand breaks and maintain genome stability.

Fig. 1

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What Is A 5

A relative survival rate compares women with the same type and stage of breast cancer to women in the overall population. For example, if the 5-year relative survival rate for a specific stage of breast cancer is 90%, it means that women who have that cancer are, on average, about 90% as likely as women who dont have that cancer to live for at least 5 years after being diagnosed.

Survival Rates For Triple

Triple-negative breast cancer is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time its found, and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.

Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. They cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.

Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as they are familiar with your situation.

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Risk Factors For Triple Negative Breast Cancer

A risk factor is a characteristic that increases an individuals chance of getting a certain condition. For example, cigarette smoking is a risk factor for lung cancer. While anyone can receive a diagnosis of triple negative breast cancer, it is more likely to affect the following individuals:

  • Those who are younger than age 40
  • Those who have the BRCA1 mutation
  • Those of African-American or Hispanic descent

Having one or more of these risk factors does not mean developing triple negative breast cancer is for certain, just as not having any of these risk factors doesnt prevent an individual from being diagnosed with this condition.

Where Do These Numbers Come From

How Is Triple-Negative Breast Cancer Treated?

The American Cancer Society relies on information from the Surveillance, Epidemiology, and End Results Program database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for breast cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead, it groups cancers into localized, regional, and distant stages:

  • Localized: There is no sign that the cancer has spread outside of the breast.
  • Regional: The cancer has spread outside the breast to nearby structures or lymph nodes.
  • Distant: The cancer has spread to distant parts of the body such as the lungs, liver, or bones.

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Adaptive Clinical Studies: Molecular Markers

Under the master protocol framework, basket trials, where a targeted therapy is evaluated for multiple diseases that share common molecular alterations, and umbrella trials, where multiple targeted therapies are evaluated for a single disease that is stratified into multiple subgroups based on different molecular factors, have been developed . Recently there have been more adaptive, signal-finding clinical trial designs coupled with correlative studies to investigate mechanisms of action. They also facilitate identifying active drug combinations as well as novel tumor indications. Patients are enrolled based on molecular markers from genetic profiling performed on their tumors. Some examples are listed below.

In The Advanced Setting

As a first-line treatment option for patients with locally recurrent, inoperable or metastatic TNBC, pembrolizumab was evaluated in combination with investigator’s choice of chemotherapy , compared to placebo plus chemo-therapy . A significant PFS benefit with the pembrolizumab-chemo combination in patients whose tumors expressed PD-L1 was reported . The study is currently in progress to evaluate OS, the other primary endpoint of the trial.

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Will Ever Be A Cure For Triple

Triple-negative breast cancer is curable when a doctor diagnoses it during the first three stages , said Dr. Jacoub. He treats stages 13 with everything he can in order to remove and destroy the cancer.

However, the ability to cure triple-negative breast cancer is hindered by recurrence or metastasis past the lymph nodes. Triple-negative breast cancer is the most likely form of breast cancer to return.

The outlook for people with localized triple-negative breast cancer over a 5-year period is good. Around 91% of people will survive to the 5-year mark.

If the cancer spreads to local tissue or lymph nodes, however, the 5-year survival rate drops to 65%. If it spreads to other organs or tissue, the rate falls to 12%.

These figures are based on data for people who received treatment in the past. Newer methods have changed the outlook, which will continue to shift as different treatments become available.

Anecdotally, Dr. Nan has a segment of patients who have responded to immunotherapy treatment for longer than 5 years.

Maybe if follows these long enough, some may still be alive after more than 10 or 15 years, then we can say cured, he said. With developed or newer types of immunotherapy, may be able to cure stage 4 cancer in the future.

Dr. Jacoub agreed that the outlook is changing with newer treatments. He also noted that although some people have a reduced quality of life while undergoing treatment, others can maintain a good quality of life.

What Does Triple Negative Mean In Terms Of Breast Cancer

#VisualAbstract: Low

Normal breast cells have receptors that respond to hormones such as estrogen and progesterone, which allows them to grow and regress in response to the hormone level. Hormone receptors may or may not be present in breast cancer. About two-thirds of breast cancers are positive and contain these receptors like normal breast cells do. These are less aggressive cancers that are less likely to need chemo and are often treated with hormone therapy and surgery. Radiation may or may not be needed.

HER2/neu , is a protein molecule that has a role in cell proliferation in normal cells. In some breast cancers, this protein is overly produced or positive. For HER2-positive tumors, there a specific medication that targets this protein.

Triple-negative breast cancers are not positive for estrogen receptors, progesterone receptors or HER2 protein. Since these targets are absent in triple-negative breast cancer, chemotherapy is needed, Sun says. Triple-negative breast cancer is often very sensitive to chemotherapy, which, despite the side effects, is an effective treatment that can save lives. Because this is an aggressive cancer, treatment is aggressive also. But there are several ways we can address it.

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Combination Therapies In Tnbc

From the results of current TNBC clinical trials, the benefit of a single conventional anticancer therapy or immunotherapy is not sufficient due to tumor heterogeneity, tumor evolution and drug resistance. Therefore, combination therapy is currently the preferred option for TNBC treatment, and we summarize the primary endpoints of clinical trials in Table and the current drug combination trials for TNBC in Fig. . From these studies, patients with nonadvanced TNBC had good responses after combination therapy however, the prognosis of advanced TNBC still remained poor. Among them, PD-L1+ patients treated with conventional chemotherapy combined with immunotherapy as first-line therapy had a good prognosis , as described in the Sect. . In addition, those patients with BRCA-associated mutations have achieved a better prognosis after combination targeted therapy . In second-line treatment, the novel ADC drug sacituzumab govitecan has been demonstrated undeniable effects , and the combination therapy of ADC is worth exploring and looking forward to. Undoubtedly, precise personalized treatment of TNBC relies on the study of molecular expression characteristics and tumor biological mechanisms. Therefore, routine immunomolecular expression assessment and mutation analysis of TNBC tumor tissues are recommended, which will provide solid evidence for determining TNBC combination therapy regimens.

Table 7 Clinical trials evaluating adoptive cell therapy in patients with TNBC

How Is Triple Negative Breast Cancer Treated

  • Surgery. You may have part of your breast removed or the whole breast . Your surgeon will probably also remove lymph nodes from your armpit area to see if the cancer has spread there. This is called a sentinel lymph node biopsy. Its usually done at the same time as the surgery to remove the tumour.
  • Chemotherapy. You might have chemotherapy before surgery to shrink the cancer and make it easier to remove. Chemotherapy after surgery can reduce the risk of the cancer coming back.
  • Radiotherapy. Radiotherapy after surgery can help to reduce the risk of the cancer coming back.

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Triple Negative Breast Cancer Treatment

When formulating a treatment plan, oncologists will take the triple negative diagnosis into significant consideration. The reason is that traditional hormone-based therapies like tamoxifen and Herceptin, which are often helpful for treating hormone-receptive breast cancers, do not affect triple negative breast cancer. Typically, triple negative breast cancer is treated with one or more of the following methods:

  • Surgery A lumpectomy or mastectomy procedure can be used to remove as much of a tumor as possible.
  • Radiation therapy Targeted, high-energy rays are used to destroy breast cancer cells.
  • Chemotherapy Drugs are administered to destroy rapidly dividing cancer cells.
  • Neoadjuvant therapy Chemotherapy or radiation therapy is administered before or after surgery.

Some patients wonder whether triple negative breast cancer should be treated more aggressively than other types of breast cancer. This is not necessarily the case. In fact, some researchers believe that triple negative breast cancer responds more favorably to chemotherapy than hormone-receptive cancers.

What Research Trials Are Underway

Yuan Yuan, M.D., Ph.D., on Triple Negative Breast Cancer Treatments | #ASCO21

There are several new and ongoing studies looking at treatments for triple-negative breast cancer.

Dr. Fancher encouraged people with triple-negative breast cancer to look into trials. Research on clinical trials is really important, she told MNT.

If you triple-negative breast cancer, consider a clinical trial. It helps move the research forward. There are lots of trials out there, and many are having good results.

Dr. Nan spoke about the Keynote 522 clinical trial . This trial is looking at the use of pembrolizumab, a type of immunotherapy, in combination with chemotherapy before and after surgery.

The trial focuses on people with stage 2 or 3 breast cancer who are at high risk, and pembrolizumab has shown some promise. In fact, the trial has shown a 65% effectiveness rate, indicating no residual signs of cancer in the tissue. This is up from 51% previously.

The phase 3 ASCENT clinical trial is looking at the use of sacituzumab govitecan, an antibody drug conjugate. In a phase 2 trial, it had shown promise in people who had previously received treatment for metastatic triple-negative breast cancer. The Food and Drug Administration gave the drug accelerated approval in 2020.

A person should talk with a doctor before joining a clinical trial. They may be able to help the person find a relevant study or recommend ones that will work best for them.

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What Is Triple Negative Early Breast Cancer

Triple negative breast cancer is a type of breast cancer that does not have any of the three receptors commonly found on breast cancer cells the oestrogen, progesterone and HER2 receptors. Around 15% of early breast cancers are triple negative.

Triple negative breast cancer generally responds well to chemotherapy. Five years after diagnosis, people with triple negative breast cancer are no more likely to experience a recurrence of their breast cancer than people with other types of breast cancer. In the longer term , a recurrence is less likely with triple negative breast cancer.

Causes Of Triple Negative Breast Cancer

The risk factors for triple negative breast cancer are not clear. Some breast cancers depend on hormones to grow. These can be linked with risk factors to do with hormones and having children. But triple negative breast cancer does not seem to share these risk factors.

Most women with triple negative breast cancer have no strong history of breast cancer in their family . But some women with triple negative breast cancer have an altered BRCA1 gene. This will have been inherited from a parent.

An altered BRCA 1 gene can cause breast cancer to run in families. Most breast cancers caused by BRCA1 are triple negative.

If you have triple negative breast cancer, you may be offered genetic testing. This is even if you do not have a family history of breast cancer. Your cancer doctor or breast care nurse can explain more about this to you.

The tests are the same as for any type of breast cancer. You usually have a:

  • Mammogram

    A mammogram is an x-ray of the breast.

  • Ultrasound scan

    An ultrasound scan uses sound waves to produce a picture of the breast tissue and the lymph nodes in the armpit.

  • Breast biopsy

    When you have a breast biopsy, your cancer doctor or breast care nurse takes small samples of cells or tissue from your breast. The samples are looked at under a microscope to check for cancer cells. They also do other tests to find out if the cells have receptors for hormones, or for HER2.

See also

The staging and grading is the same as for other types of breast cancer.

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